Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis

Yui Rwei Young, Bor Fuh Sheu, Wen Cheng Li, Ting Min Hsieh, Chi Wei Hung, Shy Shin Chang, Chien Chang Lee

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. Methods: We searched MEDLINE and Embase with no language restrictions up to May 2013. The end points were major cardiac complications. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Results: Of the 662 retrieved articles, 24 studies satisfied the predefined eligibility criteria, including 5438 patients along with 712 (13.1%) events. After major surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative MACE was 14.3 (95% confidence interval [CI], 9.87-20.7) for overall population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and 15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled sensitivity was 0.84 (95% CI, 0.79-0.88) and specificity was 0.76 (95% CI, 0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was associated with higher predictive value than preoperative measurement (DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type natriuretic peptide was associated with higher predictive accuracy (area under the summary receiver operating characteristic, 0.84; 0.81-0.87) than N-terminal pro-b-type natriuretic peptide (area under the summary receiver operating characteristic, 0.90; 0.87-0.92). Conclusions: The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.

Original languageEnglish
JournalJournal of Critical Care
Volume29
Issue number4
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

Fingerprint

Natriuretic Peptides
Brain Natriuretic Peptide
Meta-Analysis
Odds Ratio
ROC Curve
Confidence Intervals
MEDLINE
Thoracic Surgery
Language
Mortality
Population

Keywords

  • B-type natriuretic peptide
  • Cardiac complication
  • N-terminal pro-b-type natriuretic peptide
  • Surgery

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis. / Young, Yui Rwei; Sheu, Bor Fuh; Li, Wen Cheng; Hsieh, Ting Min; Hung, Chi Wei; Chang, Shy Shin; Lee, Chien Chang.

In: Journal of Critical Care, Vol. 29, No. 4, 01.01.2014.

Research output: Contribution to journalArticle

Young, Yui Rwei ; Sheu, Bor Fuh ; Li, Wen Cheng ; Hsieh, Ting Min ; Hung, Chi Wei ; Chang, Shy Shin ; Lee, Chien Chang. / Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis. In: Journal of Critical Care. 2014 ; Vol. 29, No. 4.
@article{f24a7523a9f24a2d9b991f4d7fc3a09b,
title = "Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis",
abstract = "Background: We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. Methods: We searched MEDLINE and Embase with no language restrictions up to May 2013. The end points were major cardiac complications. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Results: Of the 662 retrieved articles, 24 studies satisfied the predefined eligibility criteria, including 5438 patients along with 712 (13.1{\%}) events. After major surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative MACE was 14.3 (95{\%} confidence interval [CI], 9.87-20.7) for overall population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and 15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled sensitivity was 0.84 (95{\%} CI, 0.79-0.88) and specificity was 0.76 (95{\%} CI, 0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was associated with higher predictive value than preoperative measurement (DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type natriuretic peptide was associated with higher predictive accuracy (area under the summary receiver operating characteristic, 0.84; 0.81-0.87) than N-terminal pro-b-type natriuretic peptide (area under the summary receiver operating characteristic, 0.90; 0.87-0.92). Conclusions: The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.",
keywords = "B-type natriuretic peptide, Cardiac complication, N-terminal pro-b-type natriuretic peptide, Surgery",
author = "Young, {Yui Rwei} and Sheu, {Bor Fuh} and Li, {Wen Cheng} and Hsieh, {Ting Min} and Hung, {Chi Wei} and Chang, {Shy Shin} and Lee, {Chien Chang}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.jcrc.2014.03.022",
language = "English",
volume = "29",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",
number = "4",

}

TY - JOUR

T1 - Predictive value of plasma brain natriuretic peptide for postoperative cardiac complications-A systemic review and meta-analysis

AU - Young, Yui Rwei

AU - Sheu, Bor Fuh

AU - Li, Wen Cheng

AU - Hsieh, Ting Min

AU - Hung, Chi Wei

AU - Chang, Shy Shin

AU - Lee, Chien Chang

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. Methods: We searched MEDLINE and Embase with no language restrictions up to May 2013. The end points were major cardiac complications. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Results: Of the 662 retrieved articles, 24 studies satisfied the predefined eligibility criteria, including 5438 patients along with 712 (13.1%) events. After major surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative MACE was 14.3 (95% confidence interval [CI], 9.87-20.7) for overall population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and 15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled sensitivity was 0.84 (95% CI, 0.79-0.88) and specificity was 0.76 (95% CI, 0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was associated with higher predictive value than preoperative measurement (DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type natriuretic peptide was associated with higher predictive accuracy (area under the summary receiver operating characteristic, 0.84; 0.81-0.87) than N-terminal pro-b-type natriuretic peptide (area under the summary receiver operating characteristic, 0.90; 0.87-0.92). Conclusions: The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.

AB - Background: We aimed to undertake a systematic review and meta-analysis of studies addressing perioperative natriuretic peptide (NP) levels to predict postoperative major adverse cardiac events (MACE) after major surgery. Methods: We searched MEDLINE and Embase with no language restrictions up to May 2013. The end points were major cardiac complications. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models. Results: Of the 662 retrieved articles, 24 studies satisfied the predefined eligibility criteria, including 5438 patients along with 712 (13.1%) events. After major surgery, the diagnostic odds ratio (DOR) of NP in predicting postoperative MACE was 14.3 (95% confidence interval [CI], 9.87-20.7) for overall population, 13.9 (8.43-22.8) for patients undergoing cardiac surgery, and 15.0 (8.84-25.5) for patients undergoing noncardiac surgery. The pooled sensitivity was 0.84 (95% CI, 0.79-0.88) and specificity was 0.76 (95% CI, 0.71-0.81). Postoperative measurement (DOR, 18.9; 7.68-46.3) was associated with higher predictive value than preoperative measurement (DOR, 13.6; 7.68-46.3). Results were similar for a subgroup with the composite outcome including mortality (DOR, 16.4; 10.6-25.5). B-type natriuretic peptide was associated with higher predictive accuracy (area under the summary receiver operating characteristic, 0.84; 0.81-0.87) than N-terminal pro-b-type natriuretic peptide (area under the summary receiver operating characteristic, 0.90; 0.87-0.92). Conclusions: The existing literature suggests that perioperative NP testing have reasonable accuracy and can be useful in perioperative risk stratification. Natriuretic peptide testing has high rule-out value and low rule-in value for predicting postoperative MACE. Medical decisions should be made in the context of these characteristics.

KW - B-type natriuretic peptide

KW - Cardiac complication

KW - N-terminal pro-b-type natriuretic peptide

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84902288104&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902288104&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2014.03.022

DO - 10.1016/j.jcrc.2014.03.022

M3 - Article

VL - 29

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

IS - 4

ER -